profile: ricardo komotar, md
Dr. Ricardo Komotar, MD, FAANS, FACS
is a Professor of Neurological Surgery at the University of Miami Miller School of Medicine. Along with his clinical responsibilities as a busy brain tumor neurosurgeon, Dr. Komotar is the Program Director for the Neurosurgery Residency Training Program at University of Miami and the Director of the Surgical Neuro-Oncology Fellowship Program, helping shape the minds of future neurosurgeons from around the globe. Dr. Komotar is also the Director of the UM Brain Tumor Initiative at the University of Miami Sylvester Comprehensive Cancer Center, where he leads the effort to utilize the latest technologies to personalize cancer care for all patients. Dr. Komotar is also a groundbreaking researcher with over 350 peer reviewed publications and is focused on the role of the immune system in the treatment of glioblastoma.
Cure Glioblastoma volunteer, Steven Capone, MD, recently interviewed Dr. Komotar:
Steve Capone, MD: So, we generally do a little bit of a throwback to your residency interviews when you were first joining the field. What drew you to neurosurgery?
Ricardo Komotar, MD, FAANS, FACS: I would say what drew me to neurosurgery is the technical complexity of the procedures we do as well as the ability to make a positive difference in the lives of people to such a high degree.
SC: That's fantastic. So, within neurosurgery you specialize in neuro-oncology. How did you make the jump from general neurosurgery into CNS tumors and neuro-oncology?
RK: I would say as a resident you see everything; you see spine, you see brain, and I was drawn towards brain tumors. Again, the technical aspect I thought was great, as well as the patients and how grateful they were and how much of a positive difference you could make. So during residency you see all of neurosurgery and eventually certain parts of it you gravitate towards, and for me that was brain tumors.
SC: So, can you discuss a little bit about your research?
RK: Sure, our director of research is Dr. Mike Ivan, but I can tell you about our research. Our research here is mainly focused on primary tumors, meaning gliomas, looking at patient specific targeted therapies for gliomas. So the main issues with gliomas is that every patient with a glioma is treated the exact same way, but every single patient is different. Meaning every glioma is different. There are different mutations, and even though they're all grouped under the title “glioblastoma”, they're actually all different. And so what we're working on is treating every glioblastoma differently by trying to identify patient specific and targeted therapies that are unique for each patient.
SC: That's awesome, that's really interesting. So since you mentioned targeted therapies, where do you feel the future of glioblastoma treatment is going in your opinion?
RK: It's going to be a combination of immunotherapy and targeted patient-specific therapies. Like immunotherapy is not necessarily patient-specific, but it's “tumor-specific” and so I think most likely what we're seeing with other cancers is that immunotherapy is playing a major role. I don't know if you want me to get into immunotherapy.
SC: Yeah that would be great.
RK: That's a whole other area of research. I would say that the future of medicine is involving patient-specific therapies, and in addition immunotherapy. Immunotherapy being basically the concept that you get the body's immune system to recognize the cancer as foreign and to fight the cancer just like you would the common cold or any bacteria. So what a lot of the studies are doing is removing brain tumors, and then purifying down certain tumors that are essentially a fingerprint for the tumor. Then you reinject that in high concentration back into the patient and that fingerprint activates the immune system such that any cells that have that fingerprint get attacked. The only cells that have that fingerprint are indeed the patient's tumors.
Dr. Komotar in the clinic. (courtesy of Dr. Komotar).
SC: That's a really elegant way to try and attack the tumors. The first person I interviewed for the blog was Dr. Boockvar at Lenox Hill, and he's big on the blood brain barrier so I think those two things dovetail nicely because if you can't get your immune system to find the tumor it's kind of hard to kill it.
RK: Exactly right, exactly.
SC: So you spoke about immunotherapy, are you working on immunotherapy at Miami?
RK: Correct, we have Dr. (Macarena Ines) De La Fuente who is running our immunotherapy clinical trials.
SC: Awesome, that's really pioneering work. So to switch gears a little bit from the research side more to the clinical side, can you kind of tell me a little bit about the hardest part of your job?
RK: Finding time to do these interviews! What's the hardest part of my job? I would say just the physical grind. I would say that's the hardest part is the... let me think about that question; that's a good question I haven't really thought about that.
SC: Yeah, neurosurgery in general is a very grueling and hard specialty, so I guess picking the hardest part of it makes it even that much more difficult.
RK: Yeah I would say the hardest thing to do would be the emotional and physical toll of taking care of these patients.
SC: Yeah, a lot of times you don't have great outcomes regardless of what you do; it's a brutal disease. I think that's something that particularly in neuro-oncology, surgical neuro-oncologists have to bare the brunt of more so than others.
RK: Correct, you're dealing with a terminal disease and there's a limited amount of benefit that you can do, and that tends to add up you know? You have to know your limits and realize that you can't really help everyone.
SC: When you have a new patient come in that has a recent diagnosis of a brain tumor, whether it's low grade glioma, glioblastoma, etc., how do you approach developing a treatment plan for these patients and how do you help them cope with these diagnoses?
RK: I would say the most important thing in counseling any patient who has a brain tumor is making them feel included in a comprehensive team, because surgery is only one part of their treatment. There are a lot of important moving parts that go on when it comes to treating brain tumors, other than the surgery. The surgery is one part of their care, but you need to explain to the patient that they are part of a much bigger team. They're part of radiation oncology, medical neuro-oncology, neuro-pathology. Patients need to realize that there's a comprehensive patient-centric team taking care of them. That's what we always do here at Miami.
SC: I think that “team approach” is sometimes lost from the physicians side a bit, and from the patient side often.
RK: Correct.
SC: It's kind of something that slides past people and they don't realize what's really going on. So, you're also the program director for the neurosurgical training program at University Miami as well as involved as the Director of the Neuro-Oncology Fellowship Program. What advice would you have for younger neurosurgeons and aspiring neurosurgeons who are interested in neuro-oncology?
RK: Yeah, I would say it's an amazing field. If it's your passion, if it's something that is truly your calling, then it's worth every second. It's obviously very grueling and if it's not your calling, then I wouldn't do it. I would always tell people that it's worth the sacrifice, it's worth the commitment. It's an amazing profession and what we get to do every day… there's no job like it.
Dr. Komotar operating with former UMH fellow, Simon Hanft, MD. (courtesy of Dr. Komotar)
SC: Yeah, I think that's all very accurate. So just a little bit about you personally, I know you're very active on social media, I think there's a group now of neurosurgeons who are being more open with medical students, with the general public. That ranges from things like Lenox Hill on Netflix, to social media where people like yourself, Dr. (Michael) Lawton, have been very open and honest and showed their personality. I think you've done that quite a bit more than most. How do you view the future of neurosurgery in that sense, and the surgeons being viewed more as people and less like robots?
RK: Yeah, I mean you just said it yourself. I think that the generation or the time or the age of doctors being put on a pedestal and no-one kind of questioning their personality or who they are outside of the hospital, I think people want to know their doctor. They want to know who is operating on them and who is taking care of them, and I think getting to know your doctor more than just what their credentials are is critical. I think it's what the patients want, and I feel like doctors that are not willing to do that are going to be at a disadvantage. I think especially because social media is so prevalent now. I think, and this goes for anyone, it's doctors, lawyers, business people, if you're not willing to get out there and get on social media, or be on the internet you're really at a disadvantage. It doesn't mean you can't be successful, you still can, but it's harder. I feel like neurosurgery is no different. People want to see that their doctor has a personality or has a life or has other interests. That's important.
SC: I think anyone that follows you knows that one of your major interests tends to be fitness, so I have to ask: Who wins the competitions between you and Dr. (Timur) Urakov?
RK: That's an excellent question. Clearly me. [laughs]. We've done the MURPH, the CrossFit routine with the run a mile and then the 100 pullups, 200 pushups, 300 squats, and then run another mile, and I beat him… by roughly 10 seconds. [laughs]. So I think that you could safely say I am more fit than Dr. Urakov. Feel free to quote him on the blog!
SC: Yeah I'll at him (@timurtoto) on social media.
RK: Yeah please do. Timur is a great dude, he's one of my close friends. I respect him a lot, so we definitely have a nice rivalry going.
SC: Yeah that's very obvious. I think he likes to tag you whenever he's doing something too.
RK: He's also a great doctor and surgeon.
SC: That's great. If there's anything else you'd like to mention or plug feel free, if not I appreciate your time talking with me.
RK: Of course. What I'm most proud of is the team that we've built here. I tell everyone that, it's one hundred percent true, the reason that I'm able to do what I do is because I've surrounded myself with this team. So that's what I'm most proud of. It's not just the surgery or the surgeons but it's the comprehensive team-based approach here at the University of Miami that is world class, and that's what I'm most proud of.
SC: That's great. Oh, one last question, do we have a timeline on the softball tournament returning?
RK: We're going to try for this June. I have to get a feeler for the different programs to see if the universities are allowing travel and what have you. It will definitely be by 2022, it's a question for 2021 and seeing if it’s feasible.
SC: Hopefully someone can unseat Barrow.
RK: For god's sakes please. I'm tired of them.
SC: Alright, thank you for your time I really appreciate it Dr. Komotar.
Feature by Steven Capone, MD. Dr. Capone has been a Cure Glioblastoma volunteer since summer 2020 and is interested in a career in neurosurgery. Transcribed by Justin Thompson a Cure Glioblastoma volunteer who joined us in 2019. Justin is a former Marine and is currently a pre-med interested in a career in neurosurgery.